Modern management of ectopic pregnancy

Abstract

The modern management of ectopic pregnancy has been influenced greatly by recent advances in human chorionic gonadotropin determination and ultrasound. Serum progesterone determination holds promise as a means of identifying abnormal gestations. Early diagnosis of tubal pregnancies has prompted conservative surgical treatment and the use of medical therapy in selected cases. Because of the improvement in diagnostic aids and conservative treatment, we are documenting a change in epidemiologic profiles. The incidence of ectopic pregnancy has increased, with a concomitant decrease in mortality. Fertility after conservative surgical procedures appears improved over that with radical treatment. However, women with ectopic pregnancies continue to have reduced fertility potential.

PIP: The number of ectopic pregnancies reported to the Centers for Disease Control quadrupled between 1970 and 1985. Nearly 78,400 cases, or 1 in 66 pregnancies, were reported in 1985. Over the same 15-year interval, there was a sevenfold decline in maternal deaths related to ectopic pregnancies, 33 such deaths reported in 1985. The decreased mortality rate is due to earlier diagnosis of the condition, which allows for earlier surgical intervention. Extensive use of laparoscopy, wide availability of HCG radioimmunoassays, and technical advances in ultrasound have resulted in earlier diagnosis of ectopic pregnancy. Earlier intervention has potentiated the application of conservative surgical procedures, such as salpingotomy, salpingostomy, fimbrial expression, and segmented resection, to treatment of ectopic pregnancy. But despite improvements in surgical techniques, subsequent fertility in patients with ectopic pregnancy remains impaired. Recently medical treatment of ectopic pregnancy, usually performed with methotrexate, has been applied successfully, offering an additional treatment option.